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  • Deep Brain Stimulation of the Internal Globus Pallidus for Disabling Haloperidol-Induced Tardive Dystonia. Report of Three Cases.

    Final Number:
    245

    Authors:
    Michael Roman Sobstyl MD, PhD; Miroslaw Zabek MD, PhD; Grazyna Brzuszkiewicz-Kuzmicka MD, PhD; Tomasz Pasterski MD; Artur Zaczynski MD

    Study Design:
    Clinical Trial

    Subject Category:
    Functional Neurosurgery

    Meeting: 2016 ASSFN Biennial Meeting

    Introduction: Tardive dystonia (TD) represents a side effect of prolonged intake of neuroleptic drugs. TD can be a disabling movement disorder persisting despite available medical treatment. Deep brain stimulation (DBS) has been reported successful in this condition although the number of treated patients with TD is still limited to small clinical studies or case reports (1-3). In this study, we present 3 additional cases of patients with results of bilateral globus pallidus internus (GPi) stimulation.

    Methods: The formal assessment included the Burke-Fahn-Dystonia Rating Scale (BFMDRS). The preoperative and postoperative functional and motor parts of BFMDRS were compared in each patient.

    Results: Three patients underwent successful bilateral GPi DBS for TD. The postoperative BFMDRS motor score improved by mean of 71% at the last follow-up in each patient. There were no surgical or hardware-related complications over follow-up period.

    Conclusions: Our experience indicates that bilateral GPi DBS can be an effective treatment for disabling TD. The response of TD to bilateral GPi DBS is very rapid and occurs within days after the procedure.

    Patient Care: Our research supports the observation that tardive dystonia is good clinical indication for bilateral pallidal stimulation. The improvement is quick and robust in some patients.

    Learning Objectives: The learning objectives of this report are as follows: 1) Tardive dystonia is a good indication for bilateral pallidal stimulation. 2) The response to pallidal stimulation may be very quick and impressive in some patients. 3) The clinical improvement is observed at longer follow-up periods (36 months) postoperatively.

    References: [1] Ostrem JL, Starr PA. Treatment of dystonia with deep brain stimulation.Neurotherapeutics. 2008;5:320–330. [3] Trottenberg T, Paul G, Meissner W, Maier-Hauff K, Taschner C, Kupsch A. Pallidal and thalamic neurostimulation in severe tardive dystonia. J Neurol Neurosurg Psychiatry 2001;70:557-559. [2]. Trottenberg T, Volkmann J, Deuschl G, Kühn AA, Schneider GH, Müller J, Alesch F, Kupsch A. Treatment of severe tardive dystonia with pallidal deep brain stimulation. Neurology 2005;64:344–346. [3]. Franzini A, Marras C, Ferroli P, Zorzi G, Bugiani O, Romito L, Broggi G. Long-term high-frequency bilateral pallidal stimulation for neuroleptic-induced tardive dystonia. Report of two cases. J Neurosurg. 2005;102:721–725. [6]. Cohen OS, Hassin-Baer S, Spiegelmann R. Deep brain stimulation of the internal globus pallidus for refractory tardive dystonia. Parkinsonism Relat Disord. 2007;13:541–544.

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